For an anesthesiologist, this is the hardest part of medicine

As a cardiac anesthesiologist, there are times I care for patients who are faced with a tough decision: to take their chance on a very high-risk surgery, or let nature take its course. It is in these times I feel most humble and most human, as I may be the last one to hear the last words they speak.

Recently I was at a social event and introducing myself to some new people. A friend of mine was standing next to me, and she told me “Sasha, do you realize you’re kind of a touchy person? You reach out and touch each person you meet. That’s not normal.”

At first, I was kind of stunned, then I realized that this has become a habit of mine due to my career as an anesthesiologist. Although I read about my patients before I ever meet them, and I have may have discussed their plan with the surgeon, as an anesthesiologist I only have about 15 minutes to meet a person before I render them unconscious. That’s not a lot of time to create trust, so the first thing I do is reach out my hand and place it in theirs.

Most of the time, my patients don’t let go.

As I tell them how I will keep them safe while my surgical colleague operates, the majority of my patients, even the staunchest of men, hold my hand tightly.

They hold my hand and look into my eyes. Often times they squeeze my hand, and I squeeze back. There is a lot that transpires between us, silently.

What they are saying is this: Please take care of me. Please return me safely to these people who are in this room with me. Someone loves me. Please care for them by caring for me.

While I hold his or her hand, smiling, and talking about the anesthesia, the cardiac ultrasound and all that I plan to do, silently I am saying this as I squeeze back: I will take care of you. I will do my very best to return you to the loved ones in this room. I know you are loved. I know you are scared. I will care for you, even if it is to the end.

There is a lot that goes on in 15 minutes. We have what seem to be a hundred different checks and balances. Nurses are coming in and out the room, double checking our “take off.” Resident physicians, medical students, fellows in training, and lab technicians are in and out of the small room multiple times introducing themselves and explaining their role and procedures. I imagine, if I was the patient or a patient’s loved one, that the pre-surgical area seems very chaotic.

As the head anesthesiologist, I have a sliver of time to establish trust with my patient.

It’s why I realized I do this by reaching out, and shaking their hand.

99 percent of times at the end of the surgery, patients return to their families.

Other times, while thankfully few, they do not.

Most of these times are emergencies. A person is dying, and will die without immediate attention, and is likely to die even with our best attempts. In some of these incidents, patients may not get to whisper goodbye to their loved ones. We meet them as they are exiting ambulances and trauma bays.

But sometimes, we lose patients in heart surgery who sat in the pre-surgical room before surgery and whispered goodbye. These are cases of extremely high-risk surgeries on very sick patients. The patients and their families know this before we go into the OR.

For me, this is the hardest part of medicine.

I remember each one.

I am acutely aware I may be the last person on earth to speak to a person before I induce anesthesia. In these high-risk procedures on extremely sick people, I recognize this.

Many times I think, what were the last words they whispered to their loved ones?

What were the last words I said to them?

It is an honor, a privilege to care for people. All people. No matter what race or background or social status, we all bleed the same and we all die the same.

Medicine is a perplexing and complicated field. It is where science and structure meets humanity and suffering. Both expertise and grace are required. In the most-dire of circumstances, we need leaders. We need all hands on deck. We need commands and policies and focus.

And then the very next minute, we need grace. We need kindness and empathy and human touch. We need compassion and understanding and faith.

It is a lot.

When I open my door at the end of the day, I see my kids who need help with homework, want to tattle on their sibling, or are hungry. And all the sudden I realize that my job is a lot. At times I feel I am swinging from working in a war zone to being soccer mom. There are times I feel completely empty and sad.

And then I think of this:

I am here to play a small role in a team effort to return other moms, other dads, other sisters and brothers and grandparents to their homes so they can be asked, “Is there anything to eat?” or “Can I go to the pool with so and so?”

Every life is important. Every whisper is special.

So I get up the next day, and squeeze another hand as I say these words:

“Hello, my name is Dr. Shillcutt. And I am going to be your anesthesiologist today.”

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